Variation in Rates of Post-Mastectomy Radiotherapy Among Women with Early Invasive Breast Cancer in England and...

Area of Science:

• Oncology
• Radiotherapy
• Health Services Research

Background:

• Post-mastectomy radiotherapy (PMRT) is a crucial treatment for early invasive breast cancer (EIBC).
• Geographical variations in healthcare practices can lead to disparities in patient outcomes.
• Understanding patterns of PMRT is essential for ensuring equitable and evidence-based care.

Purpose of the Study:

• To investigate geographical variations in PMRT patterns for women with EIBC in England and Wales.
• To explore patient-specific factors influencing PMRT utilization.
• To identify potential unwarranted variations in PMRT delivery.

Main Methods:

• Analysis of national cancer data for women aged ≥50 diagnosed with EIBC (stage I-IIIa) between 2014-2018.
• Utilized multilevel mixed-effects logistic regression to assess risk-adjusted PMRT rates across regions and organizations.
• Examined variations within different recurrence risk subgroups and assessed the impact of patient case-mix.

Main Results:

• PMRT use increased with recurrence risk (15.0% low, 59.4% intermediate, 85.1% high).
• Chemotherapy use correlated with higher PMRT rates; older age (≥80) correlated with lower rates.
• Substantial regional variation in PMRT rates was observed for intermediate-risk EIBC (40.3-77.3%), with less variation in low and high-risk groups.

Conclusions:

• PMRT rates are consistently high for high-risk EIBC across England and Wales.
• Significant regional and organizational variations in PMRT exist for intermediate-risk EIBC.
• Efforts are needed to standardize PMRT practices and reduce unwarranted variations for intermediate-risk EIBC patients.